title: Limitations of current treatments for systemic lupus erythematosus: a patient and physician survey.
abstract: An independent cross-sectional survey assessed systemic lupus erythematosus (SLE) disease and treatment burden. Variables included medication classes prescribed, disease activity, flare occurrences, treatment satisfaction, and validated measures of health-related quality of life (HRQoL), fatigue and work productivity. Of 886 eligible patients (mean age 41.3 years, 89% female), 515 completed the survey. One-third reported moderate-to-severe disease activity, and 31% had flared in the last 12 months. Higher severity of disease activity (moderate-to-severe) was associated with ≥ 2 medication classes prescribed and treatment regimens that included corticosteroids (CS) (both p<0.0001). Patients receiving CS reported lower EQ-5D scores (p=0.0019) and higher fatigue levels (p<0.001), and both patients (p=0.0019) and physicians (p=0.0001) were less likely to report satisfaction with treatment regimens including CS. Among responders eligible for work (n=456), severity of disease activity (moderate-to-severe vs. mild) was associated with unemployment (52.9% vs. 40.8%; p=0.0189), greater impairment in work productivity (36% vs. 21%; p=0.0003) and participation in daily activities (41% vs. 21%; p<0.0001). This survey confirms that SLE and current treatment options substantially impair patients' health status and work productivity. Physician- and patient-reported satisfaction with current treatment regimens, despite poorly controlled disease activity, indicate they are resigned to the limitations of available SLE treatment regimens.
authors.affiliation: Division of Immunology/Rheumatology, Stanford University, Portola Valley CA 94028, USA. vstrand@stanford.edu
authors.forename: V
authors.initials: V
authors.lastname: Strand
authors.forename: C
authors.initials: C
authors.lastname: Galateanu
authors.forename: D S
authors.initials: DS
authors.lastname: Pushparajah
authors.forename: E
authors.initials: E
authors.lastname: Nikaï
authors.forename: J
authors.initials: J
authors.lastname: Sayers
authors.forename: R
authors.initials: R
authors.lastname: Wood
authors.forename: R F
authors.initials: RF
authors.lastname: van Vollenhoven
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003430:Cross-Sectional Studies; D004526:Efficiency; D004651:Employment / Q000706:statistics & numerical data; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006304:Health Status; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D017060:Patient Satisfaction; D011788:Quality of Life; D012720:Severity of Illness Index
chemical_list: D005938:Glucocorticoids
keywords: HRQoL; SLE; fatigue; productivity